Racial Ethnic Differences in the Markers of Mineral and Bone Metabolism within the Pediatric Dialysis Population

Background and objectives: Studies have demonstrated higher parathyroid hormone (PTH) and lower 25-hydroxy Vitamin D in African-American children. There is minimal information on these differences in pediatric patients on dialysis.Design, setting, participants and measurements: Differences in the markers of mineral and bone metabolism (MBM) were assessed in 661 pediatric patients. Differences by race and ethnicity over the first year of dialysis treatment were assessed using linear mixed models.Results: African-American race predicted 23% higher serum PTH when compared to Caucasian patients and Hispanic ethnicity trended toward 14.8% higher PTH. Upon gender stratification, the differences in PTH were magnified in African-American and Hispanic females who had 38% and 28.8% higher PTH compared to Caucasian females, respectively.Conclusions: The markers of mineral and bone metabolism differ by race and ethnicity within the pediatric dialysis population. Therefore, consideration of these differences may impact the goal-targeted treatment of MBM disorders

Racial-ethnic diversity in ambulatory blood pressure monitoring in children with chronic kidney disease.

BackgroundBlack adults with chronic kidney disease (CKD) have higher rates of hypertension as compared to White adults with CKD. Little is known of how race and ethnicity associate with the prevalence of hypertension in pediatric CKD patients. The aim was to compare ambulatory blood pressure monitoring (ABPM) results for patients with CKD enrolled in the Chronic Kidney Disease in Children (CKiD) study across racial-ethnic groups.MethodsPatients from the CKiD study who identified as non-Hispanic White, non-Hispanic Black, or Hispanic were included to analyze differences in ABPM results across these racial-ethnic groups. The outcomes were fitted using 3 progressively adjusted models.ResultsThis study included 501 CKiD participants with at least one successful ABPM study. Compared to White participants, Black participants had 4.2 mmHg higher mean sleep systolic blood pressure and 2.7 mmHg higher mean sleep diastolic blood pressure (p = 0.001 and p = 0.004, respectively). Additionally, Black participants had higher odds of abnormal wake systolic load (OR 1.88, 1.21-2.91, p = 0.005), wake diastolic load (OR 1.68, 1.03-2.73, p = 0.04), sleep systolic load (OR 2.19, 1.36-3.5, p = 0.001), sleep diastolic load (OR 2.01, 1.28-3.15, p = 0.002), systolic non-dipping (OR 2.02, 1.31-3.10, p = 0.001), and diastolic non-dipping (OR 2.69, 1.60-4.51, p < 0.001). Compared to White participants, Hispanic participants demonstrated only a lower sleep diastolic load (OR 0.54, 0.31-0.95, p = 0.03).ConclusionsBlack children with CKD have higher absolute nocturnal blood pressures and higher rates of abnormal dipping. Further studies are needed to determine the etiology of these differences and the clinical implications of racial-ethnic differences in ABPM outcomes within the pediatric CKD population. A higher resolution version of the Graphical abstract is available as Supplementary information